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Analysis of T1 Bladder Cancer on Biopsy and Transurethral Resection Specimens: Comparison and Ranking of T1 Quantification Approaches to Predict Progression to Muscularis Propria Invasion

Leivo, Mariah, Z., MD*; Sahoo, Debashis, PhD; Hamilton, Zachary, MD; Mirsadraei, Leili, MD*; Shabaik, Ahmed, MD*; Parsons, John, K., MD, PhD; Kader, Andrew, K., MD; Derweesh, Ithaar, MD; Kane, Christopher, MD; Hansel, Donna, E., MD, PhD*,‡

The American Journal of Surgical Pathology: January 2018 - Volume 42 - Issue 1 - p e1–e10
doi: 10.1097/PAS.0000000000000964
Special Article

Urothelial carcinoma of the bladder invasive into lamina propria on biopsy or transurethral resection of bladder tumor, termed “T1” disease, progresses to muscularis propria invasion in a subset of patients. Prior studies have proposed histopathologic metrics to predict progression, although methods vary widely and it is unclear which method is most robust. This poses a challenge since recent World Health Organization and American Joint Commission on Cancer editions encourage some attempt to substratify T1 disease. To address this critical problem, we analyzed T1 specimens to test which T1 quantification method is best to predict progression and to then establish the optimal cut-off. Progression was analyzed for all patients or for patients with definitive muscularis propria only. Multivariate analysis and outcomes modeling controlled for additional histopathologic features. Our results suggest that aggregate linear length of invasive carcinoma (ALLICA) measured by optical micrometer is far superior to other methods (P=3.067×10−6) and could be applied to 100% of specimens. ALLICA retained significance in multivariate analysis and eliminated contribution of other histopathologic features to progression. The best cut-off for ALLICA using a 30% false-positive threshold was 2.3 mm and using a 10% false-positive threshold at 25 mm, although the latter severely limited patients who could achieve this threshold. After comparison of all proposed methods of T1 quantification, we recommend the adoption of the ALLICA measurement and a cut-off of ≥2.3 mm as the best predictor of progression, acknowledging that additional nonhistopathologic methods may be required to increase broad applicability and further reduce the false-positive threshold.

Departments of *Pathology

Computer Science and Engineering

Urology, University of California at San Diego, La Jolla, CA

M.Z.L. and D.S. contributed equally.

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Donna E. Hansel, MD, PhD, 9500 Gilman Drive, MC 0612, La Jolla, CA 92093 (e-mail:

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